Jobsite Safety Survey - duplicate

• Job Name:

• Job Number:

• Job Location:

• Project Manager:

• Superintendent Name:

• Safety Representative:

• Conducted on

  Date

• Prepared by:

• Techniques and Operations

  Select Drilled Shafts Auger Cast Piles Vibratory Hammer Drilled Shaft Entry/Confined Space Entry Wirth Drill Slurry Mixing/Use Barge Operations Secant Piles

  • Drilled Shafts
  • Auger Cast Piles
  • Vibratory Hammer
  • Drilled Shaft Entry/Confined Space Entry
  • Wirth Drill
  • Slurry Mixing/Use
  • Barge Operations
  • Secant Piles

Fall Protection:

• Hazard(s)

  Safe

  At Risk

  N/A

• Competent Person:

Drill Rig(s):

• Hazard(s)

  Safe

  At Risk

  N/A

• Daily Inspection

  Safe

  At Risk

  N/A

Heavy Equipment (Endloaders/Forklifts/Bobcats):

• Hazard(s)

  Safe

  At Risk

  N/A

• Qualified Operators

  Safe

  At Risk

  N/A

Rigging:

• Hazard(s)

  Safe

  At Risk

  N/A

• Nylon Slings (Remove if stitches are ripped, core shows, cuts, etc.)

  Safe

  At Risk

  N/A

Personal Protective Equipment (PPE):

• Hazard(s)

  Safe

  At Risk

  N/A

Hand/Power Tools:

• Hazard(s)

  Safe

  At Risk

  N/A

• Superintendent's Signature:

  Sign

• Safety Representative's Signature

  Sign